Sufentanil Benzodiazepines

Recovery is sufficiently rapid with most intravenous drugs to permit their use for short ambulatory (outpatient) surgical procedures. In the case of propofol, recovery times are similar to those seen with sevoflurane and desflurane. Although most intravenous anesthetics lack antinociceptive (analgesic) properties, their potency is adequate for short superficial surgical procedures when combined with nitrous oxide or local anesthetics, or both. Adjunctive use of potent opioids (eg, fentanyl, sufentanil or remifentanil see Chapter 31) contributes to improved cardiovascular stability, enhanced sedation, and perioperative analgesia. However, opioid compounds also enhance the ventilatory depressant effects of the intravenous agents and increase postoperative emesis. Benzodiazepines (eg, midazolam, diazepam) have a slower onset and slower recovery than the barbiturates or propofol and are rarely used for induction of anesthesia. However, preanesthetic administration of benzodiazepines (eg, midazolam) can be used to provide anxiolysis, sedation, and amnesia when used as part of an inhalational, intravenous, or balanced anesthetic technique. 

Several drugs are used intravenously, alone or in combination with other drugs, to achieve an anesthetic state (as components of balanced anesthesia) or to sedate patients in intensive care units who must be mechanically ventilated. These drugs include the following (1) barbiturates (thiopental, methohexital) (2) benzodiazepines (midazolam, diazepam) (3) opioid analgesics (morphine, fentanyl, sufentanil, alfentanil, remifentanil) (4) propofol (5) ketamine and (6) miscellaneous drugs (droperidol, etomidate, dexmedetomidine). Figure 25-2 shows the structures of... 

In general the combined use of benzodiazepines with atfentanil or fentanyl is synei istic but may also result in additive effects on respiratory depression and/or hypotension. A pharmacokinetic study found that fentanyl reduced the metabolism of midazolam. Retrospective evidence suggests that midazolam can increase the dose requirement of sufentanil, but midazolam did not alter the analgesic efficacy of fentanyl in healthy subjects. 

Inereased sedative and respiratory depressant effeets are to be expeeted when benzodiazepines are used with opioids. The manufaeturers of sufentanil and alfentanil suggest that elinieally important hypotension may oeeur and this may be exaeerbated by the use of benzodiazepines it would seem prudent to be alert for this. The manufaeturers of transdermal fentanyl also warn of the possibility of respiratory depression, hypotension, profound sedation and potentially coma with concurrent CNS depressants including benzodiazepines. When such combined therapy is contemplated, the dose of one or both drugs should be significantly reduced. ... 

Opioid analgesic drugs (OADs), particularly fentanyl and its analogs alfentanil, remifentanil, and sufentanil, are extensively used for anesthesia and analgesia. Administration of intravenous hypnotics and OADs as a high dose opioid, low dose hypnotic (usually a benzodiazepine such as midazolam) has found wide application in cardiac anesthesia and to produce procedural sedation for endoscopy, catheterizations, and a variety of other surgical procedures where sedation and... 

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